Improving the integration of care for trans adults
Bibliographic record
Abstract
bBackground/b \nbr/br \nThis research concerns improving the National Health Service health services trans adults need. These include the national specialist Gender Identity Clinics that support people making a medical transition. Not all trans people need to make a medical transition, and transition can take many different paths. Waits to be seen by Gender Identity Clinics are, however, several years long, and there may be significant problems of co-ordination between different aspects of transition-related care, and between transition-related care and general health care. \nbr/brbr/br \nbObjectives/b \nbr/br \nThe main objectives were to understand: \n - Which factors make services more or less accessible and acceptable to the variety of trans adults? \n - How initiatives for providing more person-centred and integrated care can be successfully implemented and further improved? \n br/brbr/br \nbDesign, data sources and participants/b \nbr/br \nAn online and paper screening survey was used to gather data on demographics and service use of trans people across the United Kingdom, with 2056 responses. Researchers used survey data to construct five purposive subsamples for individual qualitative interviews, identifying groups of people more likely to experience social exclusion or stigma. There were 65 online interviews. In addition, 23 trans Black people and people of colour attended focus groups. \n \nSix case studies were completed: four on initiatives to improve care and two on experiences of particular trans populations. Fifty-five service provider staff and 45 service users were interviewed. \nbr/brbr/br \nbResults/b \nbr/br \nThe following undermine person-centred co-ordinated care and can lead to experiences of harm: \n - lack of respectful treatment of trans people by general practitioner practices; \n - inadequate funding of services; \n - lack of support during waiting; \n - the extended and challenging nature of Gender Identity Clinic diagnostic assessments, sometimes experienced as adversarial; \n - breakdowns in collaboration between Gender Identity Clinics and general practitioner practices over hormone therapy; \n - lack of National Health Service psychological support for trans people. \n \nCase studies indicated ways to improve care, although each has significant unresolved issues: \n - training in trans health care for general practitioners; \n - third-sector peer-support workers for trans people who come to National Health Services; \n - gender services taking a collaborative approach to assessing what people need, clarifying treatment options, benefits and risks; \n - regional general practitioner-led hormone therapy clinics, bringing trans health care into the mainstream; \n - psychology services that support trans people rather than assess them. \nbr/brbr/br \nbLimitations/b \nbr/br \nSome contexts of care and experiences of particular groups of trans people were not addressed sufficiently within the scope of the project. While efforts were made to recruit people subject to multiple forms of stigma, there remained gaps in representation. \nbr/brbr/br \nbConclusions and future work/b \nbr/br \nThe findings have significant implications for commissioners and providers of existing National Health Services gender services, including recently established pilot services in primary care. In particular they point to the need for assessments for access to transition care to be more collaborative and culturally aware, implying the value of exploring informed consent models for accessing transition-related care. Further research is needed to investigate how far the findings apply with particular subpopulations. \nbr/brbr/br \nbStudy registration/b \nbr/br \nThis study is registered as Research Registry, no. 5235. \nbr/brbr/br \nbFunding/b \nbr/br \nThis award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/51/08) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 28. See the NIHR Funding and Awards website for further award information.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.022 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.016 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".